MEDICARE: ORDRIAN SULLIVAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	374U00000X	Home Health Aide

General Provider Information

NPI Number	:	1952815953
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ORDRIAN SULLIVAN

Provider Business Mailing Address
First Line	:	832 CLIFFORD AVE
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44306-2300
Country	:	US
Telephone Number	:	330-777-9181
Fax Number	:

Provider Business Practice Location Address
First Line	:	832 CLIFFORD AVE
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44306-2300
Country	:	US
Telephone Number	:	330-777-9181
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/29/2017
Last Update Date	:	11/29/2017

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Directions to “ ORDRIAN SULLIVAN ” Practice Location

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